Today, many persons with significant physical disabilities live long and productive lives. As do others later in life, these individuals can develop life-threatening comorbid conditions, such as cancer. However, since patients with substantial physical impairments are often explicitly excluded from clinical treatment trials, little scientific evidence is available to guide the therapeutic decisions of persons with disabilities and their physicians. Making such critical decisions is complicated for many patients, but persons with physical disabilities might confront special challenges. Patients must contemplate not only the potential clinical implications of their impairments for cancer treatments and their side effects, but also very practical questions, such as the impact on independent living, the performance of basic daily activities, and the use of mobility aids and other assistive technologies. Cancer could further complicate patients' perceptions of their health and physical and emotional well-being, already tied, in complex ways, to their disabilities. For physicians, decisions may be affected, consciously or unconsciously, by pervasive societal stigmatization of certain physical disabilities and misperceptions about patients' actual abilities, quality of life, and preferences for care. This R21 project, submitted in response to PA-05-017 ("Decision-Making in Cancer: Single-Event Decisions") will explore decisions about primary and adjuvant treatments for women with significant pre- existing physical impairments who develop Stage I or II breast cancer under 60 years of age. The two specific aims are to: (1) explore factors women with significant physical disabilities and their families consider in making initial breast cancer treatments; and (2) to examine how breast surgeons, radiation oncologists, and medical oncologists make therapeutic recommendations for these women. We plan to conduct in-depth, individual interviews with 20 women with physical disabilities and a designated family member, as well as interviews with 15 expert physician "key informants" and 20 practicing physicians caring for breast cancer patients. The latter interviews will draw upon case vignettes that highlight key aspects of decision-making for this population. Very little published information exists about the experiences of women with significant physical disabilities who develop breast cancer. Our findings will help begin educating patients and physicians and could perhaps improve breast cancer care for women with physical disabilities. [unreadable] [unreadable] [unreadable]